Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 9427 | OK |
NPI | 1023103322 |
---|---|
Provider Name | Mr. Nathan E Bradley |
First Address | Oklahoma City, OK 73112 |
Second Address | Oklahoma City, OK 73112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 03/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C94712 | (02) | OK |